Barriers to the practice of APRN.

ANA supports the removal of barriers and discriminatory practices that interfere with full participation by advanced practice registered nurses in the health care delivery system.

Background

The Balanced Budget Act of 1997 (P.L. 105-33) expanded reimbursement opportunities for advanced practice registered nurses (APRNs) by removing geographical and practice site restrictions for Medicare Part B reimbursement. However, APRNs continue to face significant barriers presented by other changes in the health care delivery system. These barriers include restrictive reimbursement policies of both the Medicaid program and private insurers as well as numerous state laws and regulations. Among the latter are those that limit prescriptive authority, require supervision by or collaboration with another health care provider, limit direct reimbursement, prohibit or limit institutional privileges, and make it difficult to obtain liability insurance.

In addition, as managed care organizations have grown to dominate health care delivery, increasing numbers of managed care organizations have become multi-state corporations that establish their own set of rules. These rules include the exclusion from access to managed care organization provider panels and the imposition of additional practice restrictions. New strategies need to be developed and implemented to promote the recognition of APRNs as cost-effective valuable providers, to counteract these additional barriers and to counteract the increased efforts by organized medicine to limit APRN practice. ANA believes that the solution to the removal of these practice barriers must be addressed at both the federal and state levels as well as throughout health care systems, including federal systems, private insurers, fee-for-service structures, and managed care.

Rationale

The removal of arbitrary practice restrictions is crucial to achieving universal access and coverage of health care services. The full participation of registered nurses in the health care system will make access to health care affordable, available, and accountable.

ANA has consistently supported reimbursement and practice policies to ensure that all nurses are able to participate in health care systems without artificial barriers preventing their ability to practice and to be paid for those services. ANA supports legislation that prohibits discrimination by individual health plans based on the type, license, class, or specialty of a health care provider. Health plans must be required to make public, in advance, the criteria used to select participating providers and must have a sufficient mix of providers to ensure enrollees adequate access to covered services. States must not have the authority to impose on any class of healthcare professionals arbitrary practice restrictions that are not based on the licensure of those professionals. Specific language should direct states to eliminate practices that prevent registered nurses from delivering health care within their scope of their education, abilities, and competence.

ANA supports initiatives that remove arbitrary practice restrictions or prohibit policies that promote barriers for APRN practice including any laws, regulations, or policies that limit or prohibit prescriptive authority, require supervision by another health care provider, limit direct reimbursement, prohibit or limit institutional privileges, and make it difficult to obtain liability insurance.

Nursing's Legislative Continued Nursing's Legislative and Regulatory Initiatives for the 109th Congress

American Nurses Association, Department of Government Affairs

Phone: [phone] x http://www.anapoliticalpower.org